A few days ago, a neighbor on Nextdoor complained his daughter had been scammed out of her free annual physical that is guaranteed under Obamacare. She had gone to a physician’s office operated by my old, old health care system employer to get her annual physical. The clinic had apparently performed more services than were reimbursed as preventive services and his daughter was asked to pay $111. This does not surprise me in the least. The daughter’s mistake was probably asking for an annual physical rather than her Obamacare free annual wellness exam. There is a difference between wellness and a physical exam. The following is from Microsoft Edge AI Copilot:
The biggest difference between your annual wellness visit and a physical exam is that your wellness visit is a discussion about your health with your doctor. In contrast, the physical exam is a hands-on checkup to determine your current health status.
Do these sound the same? I did not realize how much difference there was, and I have written about Obamacare for 15 years. Advent Health even has a page discussing the difference. It is worth reading but too long to excerpt here.
The free annual wellness exam does not pay providers well. Providers look for any excuse to up code and enhance the charges for poorly reimbursed services. Furthermore, anything – and I mean anything – you do during that visit can elevate the charges from a free wellness exam to a diagnostic exam you must pay for. I talked to a banker at Bank of America last year and she had her own story about asking for bloodwork during her wellness exam and receiving a bill for $300 she did not expect.
The annual wellness exam is worthless because you cannot discuss any health issue likely to be a problem. Doing so makes the exam diagnostic, which are not covered by Obamacare’s preventive care mandates. Let’s say you visit your doctor requesting a colonoscopy. A colonoscopy is free once every 10 years beginning at age 45 under Obamacare. If your doctor asks you why you want one, do not say you have blood in your stool, bloating, irritable bowel syndrome or anything remotely involving your colon. Doing so could turn a $2,000 preventive service under Obamacare into a diagnostic procedure you have to pay for.
On April 21st the Supreme Court heard oral arguments about the constitutionality of the preventive services mandate under the Affordable Care Act. The following is from the New York Times:
At issue is a part of the 2010 health care law that established a task force that determines certain kinds of preventative health measures that insurance companies are required to cover.
Two small Christian businesses that provide health insurance to their employees, along with some Texas residents, had sued the federal government, challenging the constitutionality of the task force.
In particular, they had objected on religious grounds to the task force’s approval of no-cost H.I.V. medications, claiming the drugs “encourage and facilitate homosexual behavior.”
The challenge has to do with a controversial recommendation that the U.S. Preventative Services Task Force made requiring full coverage of drugs that prevent HIV transmission in men at risk. The cost is $42,000 a year. A ruling in favor of the challengers could be wide sweeping:
But the case, Kennedy v. Braidwood Management, could have broader implications for tens of millions of Americans who receive a wide array of free health care services, including cancer and diabetes screenings, medications to reduce heart disease and strokes, and eye ointment for newborns to prevent infections causing blindness.
A ruling in favor of the challengers could mean that insurers would no longer be required to offer free coverage for any care the United States Preventive Services Task Force has recommended since 2010.
Whether or not it is a good idea to mandate preventive service is a worthy debate. The problem with mandates is that without hospitals and health plans competing on the basis of price, quality and other amenities, the services are likely to become worthless. As mentioned above, the annual wellness discussion cannot cover any actual health problems without becoming diagnostic. What benefit is prevention if you are not allowed to provide input into what you are trying to prevent?
NYT: Supreme Court Wrestles With Challenge to Affordable Care Act Over Free Preventive Care
Advent Health: What is the difference between a wellness visit and a physical exam
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